Raising a T2 Voice Against Complacency

Recent headlines regarding home blood glucose monitoring for Type 2 diabetics (aggregated at the UK’s National Health service site, ) are causing a lot of concerns among the OC.

To some degree, the T2 OC is the “choir” of aggressive self-management – we are more likely than the “Average Joe With Sugar” to test regularly, to pay attention to diet and exercise, and to keep up with our medical care. To that degree, I admit to “preaching to the choir”. Or maybe just ranting…

As with any controversial research, there are ways to skew the data and there are ways to skew the conclusions.

The research:
The study had too few participants, for too short a period of time, and not testing nearly enough. For T2 testing to mean anything, one still needs to test for tight control just like T1s (minimum 8 tests/day: rising, pre- and post-prandial, retiring) and -- because it is T2's only way of affecting those numbers -- adjust one's diet and exercise based on the results of the meter. Additional checks before and after exercise, and when dealing with unfamiliar foods (or unfamiliar quantities of familiar foods), help in the overall picture.
Insurance Coverage and the costs of medical care:
Health Insurance companies have been slow to get on the "preventative care" bandwagon, and therefore, have been slow to acknowledge the need for sufficiently frequent blood glucose testing to maintain tight control. The cost of testing supplies is seen as an expense, and the goal of these companies is to minimize their expenses. Many folk with T2 are told that their insurance either won't pay for strips or won't pay for more than 1 test a day (or less). When I was first diagnosed in 2002, my PCP told me insurance companies ***would not pay for more than 4 tests a day, FOR SOMEONE ON INSULIN***... Per the recent Discovery Channel special on health care in various nations, the United Kingdom's National Health Service is so terribly underfunded that any excuse to not see a patient or to not pay for consumables is an excuse that MUST be implemented.
Medical advice:
The lack of coverage for testing supplies, and patients' unwillingness to foot the bill for the uncovered portion of their testing supplies, leads PCPs and CDEs to advise T2s either to test daily, always at the same time, or to test in a pattern at specific different times on different days of the week. The result that is it takes much longer for patterns to appear and for the numbers to have any meaning. The waiting game can cause anxiety, especially if the patient is treated like the proverbial mushroom and charged retail prices for his testing supplies.
Patient Self-Management:
Another issue in the effectiveness of blood glucose testing for NIDDM patients is the how aggressive the patient is willing to be in his diabetes self-management. If the patient is not willing to adjust his diet and exercise based on the readings and trends, and if the patient is not willing to keep track/keep a log/understand the meaning of the numbers, testing becomes expensive, painful, time-consuming, and -- to the best of his understanding -- irrelevant.

All of these issues need to be addressed for blood glucose testing to be meaningful to T2 patients.

  • My Other Half (also T2) and I test regularly, and pay attention to the readings. For us, testing is meaningful because it allows us to monitor our conditions and minimize our reliance on oral pharmaceuticals.
  • The Other Half's father (also T2) was told to test only upon waking and upon retiring. For him, testing is mostly a hollow exercise in log-keeping for the doctor (though he does understand "lows").
  • My mother (also T2) was never advised to test. When I approached the subject, I found she is not interested in testing. For her, testing is irrelevant because she is not interested in gaining additional insight into her body beyond her PCP's basic "you're doing OK".

While the program needs to be geared to the individual patient, a more aggressive approach to patient self-management, including a meaningful understanding of blood glucose levels and the reasons for home blood glucose monitoring, are needed to improve monitoring compliance and long-term outcomes. And testing anxiety should not be measured on people who are still learning how to make sense of the numbers.